The Expanded Programme on Immunization in Thailand

1. The Expanded Programme on Immunization in Thailand The implications for The border provinces And The Displace Person Tempolary Shelter Pornsak Yoocharoen, MD. Bureau of General Communicable Disease, DDC, MOPH

2. Administrative system for EPI in Thailand Ministry of Public Health National Vaccine Com. Advisory Com. On Immunization Practice (ACIP) Immunization policy Technical support Dept of Disease Control • BoE • Bogcd • 12 Reg. Off. DPC Permanent Secretary Office Monitoring, Supervision Technical support Administrative monitoring & control Provincial Health Office National Health Security Office : NHSO monitoring & control Budget Planning and Procurement Hospital, Health Center GPO Immunization Services Vaccine storage and supply (VMI)

3. Immunization Policy Immunization is the basic health need All people have the right to be prevented from VPDs The service must be provided with equality and free of charge The service must be safe and in good quality

4. Immunization Target and Strategies Polio Eradication Measles Elimination Neonatal Tetanus Elimination • Maintain high vaccine coverage (>90%) • Keepgoodqualityin vaccine administration • &coldchainmanagement • Assessment Immunization Standard • and Accreditation • AEFI surveillance & management

5. Current vaccines in EPI 20 – 25 M. US$ Vaccine • BCG • HB • OPV • DTP-HB • DTP • JE • dT • MMR

6. Current National Immunization Schedule * Started in 2010;# = 1 month apart from JE1

7. Vaccine procurement and distribution by VMI system (NHSO) Oversea manufacturers National Health Security Office (NHSO) Air port Local manufacturer (GPO, TRCS) GPO Monthly supply Vendor Managed Inventory(VMI) Hospital storage (CUP) Health care provider (HC) DPTS

8. Pertussis Measles Neonatal Tetanus Diphtheria Encephalitis Case rate/100,000 (case / 100,000 live births in NNT) Start JE vaccine in 1991 (17 provinces) Vaccine coverage EPI vaccine coverage and disease incidence, 1977-2012 Source: EPI, Bureau of General Communicable Diseases, DDC MOPH

9. Vaccine coverage in < 5 years Thailand1999, 2003, 2008 Vaccine 1999 2003 2008 BCG 98 99 99.9 DTP3 97 98 98.7 OPV3 97 98 98.7 HB3 95 96 98.4 Measles 94 96 98.1 JE2 84 87 94.6 JE3 - 62 89.3 DTP4 90 93 96.5 DTP5 - 54 79.4 T2 (or booster) 90 93 93 National Immunization Program, Thailand

10. Vaccine coverage survey in primary school, gr.1 and gr.6 in 2008 Vaccine Coverage (%) MMR gr.1 91.7 dT gr.6 94.1 National Immunization Program, Thailand

11. Remote area Hard to reach Migratory pop. Urban slum Illegal migrant worker Mobile team Closed monitoring Coverage Epidemiological surveillance High Risk Group : People in … • Keep Up • Catch Up • Mop Up

12. AEFI Surveillance system MOPH WHO DDC EPI, GCD FDA (Regulation, Licencing) BOE (AEFIs) Regional DDC (monitoring) MDSC (lot release, vaccine lab testing) PHO, BMA Data flow Data feedback Hospital, Health Center, Imm. Clinic IPD, OPD, Well baby clinic

13. Risk factors and Warning Signs Insurgency & Insecurity Distrust in Health Services Health Reform Low Vaccine Coverage Geographical Barriers & Difficulties Believe & Concerns Migratory Pop. Severe AEFI & Rumors VPD Outbreak

14. Challenges Poor vaccine coverage or unknown in … unrest areas migrant workers (Thai and non-Thai) DPTS • Free movement of workers in SEAR from the declaration of AEC • Undetected and un-controlled displace persons and illegal migrant workers move in and out the temporary shelters

15. Challenges Many outbreak of VPDs were related to foreign migrant workers Measles (Myanmar worker) Rubella (Cambodian worker) Diphtheria (Lao hill tribe, Mong) • Canceling of immunization coverage report from local and provincial level, keeping data at local area but no data at national level.

16. Challenges Changing of budget allocation from MOPH to NHSO, limitation of budget but increase flexibility of budget management. • By law, the NHSO will support vaccine only Thai but not include non-Thai population • Dilemma of command line between MOPH and NHSO (direct command and financial support)

17. Challenges To harmonize the separated function of immunization services by EPI program and vaccine procurement and delivery system by NHSO • Reduce of health staff and Increase of treatment care from public sector and health care reformation • High turn over rate among immunization health personnel

18. Opportunities • Fully support at national level, NHSO have potentially supported with high level of finance. • Outsource of the delivery system to public-private sector using Vender Manage Inventory system (VMI). • Potentially support equipment for cold chain system. (Refrigerator, vaccine carrier, thermometer …)

19. Next steps implication • To convince the NHSO should have fully support the routine immunization vaccines to DPTS and also others foreign children who live in Thailand. • To co-operate with neighboring countries around Thailand should intensify routine immunization activities to increase and maintain high vaccine coverage, more than 90%, in every country.

20. Thank You An ounce of prevention is always better than A pound of cure.